Government of Newfoundland and Labrador
Department of Finance
Taxation and Fiscal Policy Branch
Tax Administration Division
APPLICATION FOR A REBATE OF GASOLINE TAX UNDER THE REVENUE ADMINISTRATION ACT FOR FISHERS/FARMERS
PLEASE TYPE OR PRINT IN INK WHEN COMPLETING THIS FORM AND FORWARD, WITH ORIGINAL PURCHASE INVOICES & FISHING/FARMING
LICENCE(S) TO: DEPARTMENT OF FINANCE, TAX ADMINISTRATION DIVISION, P.O. BOX 8720, ST. JOHN'S NL A1B 4K1
SECTION 1: NAME, ADDRESS AND RELATED INFORMATION
DATE OF BIRTH (YY-MM-DD)
NAME
SOCIAL INSURANCE #
ADDRESS
TELEPHONE #
POSTAL CODE
EMAIL
COMMERCIAL FISHING VESSEL #
(
)
-
FISHER ID #
FARMER ID #
SECTION 2: CALCULATION OF REBATE Provide a summary of the tax rebate you are requesting. ATTACH AND COMPLETE Rebate Summary Sheet
with the ORIGINAL INVOICES and a copy of your fishing/farming licence(s). The original invoices will be returned after the claim is processed.
Gasoline Tax:
A. Period covered by this claim: From
/
Month
To
/
Day
Year
____________ Litres of Gasoline @ 16.5 ¢ per litre
$
____________ Litres of Gasoline, Southern Labrador @ 15 ¢ per litre
$
B. Period covered by this claim: From June 2, 2016
June 1, 2016
To
/
Total Rebate Claimed: (A + B)
/
Month
Day
____________ Litres of Gasoline @ 33 ¢ per litre
$
____________ Litres of Gasoline, Southern Lab & Lab West @ 23 ¢ per litre
$
DO NOT INCLUDE GASOLINE
OR FUEL USED IN MOTOR
VEHICLES.
Year
$
A COPY OF YOUR FISHING/FARMING LICENCE(S) MUST BE INCLUDED WITH YOUR REBATE APPLICATION COVERING THE CLAIM PERIOD.
SECTION 3: CHANGES Please report all changes in equipment (including boats and/or vessels), licences, and/or permits since filing your original
registration form. (Attach a list if space is insufficient).
EQUIPMENT ADDED:
Make and Type
Horse Power
Type of Fuel
Equipment Usage
Horse Power
Type of Fuel
Equipment Usage
EQUIPMENT DELETED:
Make and Type
NEW LICENCE, PERMIT, OR C.F.V. NUMBERS OBTAINED:
Number
Type of Licence or Permit (If C.F.V. number, enter details of boat length & motor make & horsepower)
SECTION 4: CERTIFICATION AUTHORIZATION
I hereby authorize the release of my income tax return(s) for the year(s) to which any rebate claim applies, and any other relevant documents,
directly to the Department of Finance to allow it to carry out its responsibilities in administering the Revenue Administration Act. I also certify that
the information contained in this application is correct to the best of my knowledge and belief and that the gasoline purchased has been used for a
tax exempt purpose. I understand that it is a serious offence to make a false statement on this form. Persons filing fraudulent claims may be subject
to prosecution.
NAME (Please Print)
TITLE
SIGNATURE
DATE
Privacy and Confidentiality Notice
This information is collected for the purpose of the Department of Finance to process applications under the Revenue Administration Act. All
information you provide, both personal and business related, will be kept confidential and compliant with the Access to Information and Protection
of Privacy Act, 2015 ( www.assembly.nl.ca/Legislation/sr/statutes/a01-2.htm ). If you have any questions regarding privacy and confidentiality
please contact the Tax Administration Division toll free at 1-877-729-6376.
SEE INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM
OFFICE USE ONLY
Total Rebate Claimed
Reviewed by
Date
Adjustments
Rebate Amt. Approved
Approved by
______________________________________
Date _____________________
Government of Newfoundland and Labrador
Department of Finance
Taxation and Fiscal Policy Branch
Tax Administration Division
INSTRUCTIONS
1)
IF YOU ARE NOT CURRENTLY RECEIVING PAYMENTS FROM THE PROVINICIAL GOVERNMENT BY DIRECT
DEPOSIT OR ELECTRONIC FUNDS TRANSFER (EFT):
In order to receive your payment, please complete the Supplier Setup and Maintenance Form attached.
Please follow the instructions provided on the form and return to the Department of Finance as indicated
below. Attach a void cheque or include certification from your financial institution.
Completed Supplier Setup and Maintenance Form must be sent to:
By Mail:
Office of the Comptroller General
Confederation Building, 3rd Floor, East Block, West Wing
P.O. Box 8700, St. John's NL A1B 4J6
Attention: Financial Systems Control Division - Supplier Maintenance
By Fax: (709) 729-2098
By Email: Electronic/scanned copies may be emailed to [email protected]
2)
A Rebate Claim should normally cover a period of at least 3 months and be greater than $100.
3)
The following documentation is required:
a) A properly completed Registration Information Form that has been signed by the applicant (FIRST TIME
APPLICANTS ONLY).
b) A properly completed Rebate Application form which has been signed by the applicant.
c) A Rebate Summary Sheet must be properly completed and attached to this Rebate Claim.
d) Original invoices must be attached to the application. These will be returned after the rebate has been
processed.
e) Fishing/farming licence(s) for the claim period must be attached to this Rebate Claim.
4)
All invoices must meet the following criteria:
a) The invoice must be an original.
b) The invoice must clearly show the seller's name.
c) The invoice must clearly show the purchaser's name.
d) The invoice must clearly show the quantity and type of fuel purchased and total price charged
(including all applicable taxes).
e) The date of the purchases must be within the claim period of this claim.
f) The date of the purchase must coincide with the fishing/farming licence season.
g) A receipt indicating payment of the invoice.
5)
Rebate claims must be received by the Department within three years of the date of purchase.
6)
For the purpose of the reduced gasoline tax rates in Labrador:
- Southern Labrador includes from the Quebec border to and including the community of Red Bay; and
- Labrador West includes Labrador City and Wabush.
7)
Clear diesel is NOT eligible for rebate. Applicants using diesel for a tax exempt purpose should apply
to the Department for a permit to purchase marked diesel.
8)
Rebate claims usually take about 8-10 weeks to be approved and payment issued. If after this period,
you have not been contacted concerning your claim, your inquiry may be directed to:
Department of Finance
Tax Administration Division
Confederation Building, 3rd Floor, East Block
P.O. Box 8720
St. John's NL A1B 4K1
Telephone: 1-877-729-6376
Fax: (709) 729-2856